logo 19 • CAMLOG Partner Magazine • December 2018 20 without mesial relief and with papillary preservation in the anterior region. Vestibular relief was performed in the retromolar region. After preparation of a mucoperiosteal flap, the threedimensional defect was exposed (Fig. 10). The soft tissue volume was increased by periosteal slitting and tunneling in the vestibule. The fit of the mesh was checked intraoperatively (Fig. 11). Preparation of the implant bed (Fig. 12) was performed in accordance with the usual procedures using the positioning splint parallel to the adjacent teeth. The final apical height was prepared with bone condensers (SCREW-LINE osteotomy set/angulatedconvex, CAMLOG), the bone quality was condensed and the predrilled bone compartment enlarged. The basal sinus floor was checked intraoperatively for completeness. The implant (CAMLOG SCREW-LINE, diameter 5/0, length 11) was inserted under the mesh in the ideal position for the implant prosthesis, which had been calculated in advance (Fig.13). The implant could be inserted primary stable (bone quality 2 according to Adell) in spite of anchorage in the bone only being possible apically. Compensation of the coronal deficit was performed with autologous bone and bone substitute material (Bio-Oss® 1-2 mm, Geistlich Pharma) at a mixing ratio of 1:1. Autologous bone was harvested from the retromolar region and the facial sinus wall using a Safescraper. The prepared mesh was filled with described augmentation material. It was then fixed to the remaining bone with an osteosynthesis screw (Medicon Mikro 1.2/7, Medicon) inserted mesio-bucally to the implant (Figs. 14 and 15). In addition, a collagen membrane was applied occlusally to the mesh (Bio-Gide®, Geistlich Pharma). The wound was closed tightly and tension-free over the titanium framework with single button and deep mattress sutures (5.0 Gore-tex suture, Gore). The postoperative X-ray showed the implant at the planned position with significant vertical bone gain (Fig.16). Continuity of the basal maxillary sinus boundary was still preserved. Postoperatively, the patient received instructions on prosthesis abstention and adequate oral hygiene. The sutures were removed after 10 days at clinically irritation-free wound conditions. After a healing period of 4 months, explantation of the titanium mesh and exposure of the implant were performed in the second intervention. The same local anesthesia was used during the procedure and a minimally invasive ridge incision was made from 5 to 7 without relief. After preparation of a full flap, the fixation screw was removed and the mesh was separated at the coronal predetermined breaking point. The two individual parts could be removed with gentle extrusion movements using the raspatory. The augmented bone volume displayed stable peri-implant dimensions and good vascularization. There were no signs of any inflammation. The cover screw on the implant was replaced by a wide-body gingiva former and tensionfree wound closure was performed. The periotest value (8.0) indicated stable bone integration. The sutures were removed one week later. Radiological control after 6 months revealed no vertical collapses and stable osseous conditions. The maxillary sinus continued to remain free of irritation (Fig 17). The patient was then referred back to the family dentist for further prosthetic Fig. 17: The OPG taken after exposure and mesh removal, displays a stable vertical bone level without losses. Fig. 18: Radiologically, the vertical bone level appears stable even after 2 years. The maxillary sinus is inconspicuous. Restapical ostitis at 24 has disappeared. Fig. 16: : Radiological documentation after insertion of the implant without sinus lift and with titanium mesh. CASE STUDY Fig. 10: Defect situation in region 26 after mobilization of the mucoperiosteal flap – slight transversal deficit. Fig. 11: The sterile titanium mesh for the area to be augmented was tried in situ. Fig. 12: The implant bed was prepared to Ø 5.0 mm / L 9 mmwith drills, followed by further preparation with convex bone condensers.
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